The phrase incident-to is used in two very different ways in the Social Security Act (SSA). For physicians and practitioners, this phase is used for incident-to billing that relates to physician coding and billing for subordinate staff services. For hospitals, the phase is incident-to services that describe the major benefit category for hospitals under the Medicare program. Hospitals are paid for services that are incident-to services provided by physicians. Confusion is created through the very different ways in which incident-to must be interpreted.
Proper compliance with all the rules/regulations that relate to both incident-to billing and incident-to services is a major challenge. In this workshop, we compare and contrast the two different interpretations, how to remain compliant in both cases and the interplay between these two concepts. Special situations such as for CAHs and RHCs will also be included. Also, the recent change by CMS to move from direct to general supervision for hospital outpatient services are discussed.
- Why does CMS frequently refer to incident-to services?
- What does incident-to really mean?
- How does incident-to relate to hospitals and physicians?
- Does incident-to have anything to do with physician supervision?
- Is incident-to a compliance issue?
- What are the rules and regulations surrounding incident-to services?
- Are there differences between physician clinics and hospitals relative to physician supervision?
- Why did CMS make the change from direct supervision to general supervision for hospital outpatient services?
- How do physician supervision and incident-to relate to the provider-based rule?
- How do physicians use the incident-to process for billing?
- How does the Social Security Act use the phrase incident-to?
- For physician supervision and incident-to, are there compliance implications?
- Is there anything special about CAHs and small rural hospitals?
- To review and discuss the two different uses of the phrase, incident-to, as provided in the Social Security Act (SSA).
- To discuss the incident-to billing for physicians.
- To appreciate hospital payment relative to incident-to physician services.
- To understand physician supervision for both physicians and hospitals.
- T explore the change that CMS has made to move from direct supervision to general supervision for hospital outpatient services.
- To discuss hospital benefit categories under the SSA.
- To understand how incident-to is a compliance issue in multiple situations.
- To show how the incident-to concept applies to recently changed physician supervision requirements.
- To discuss incident-to physician services in the provider-based clinic setting.
- To review how incident-to is involved in special situations such as the 3-Day Payment Window, RHCs and telemedicine.
- To appreciate how the rules for supervision have morphed over time.
- To understand the nonenforcement of the supervision rule for CAHs and small rural hospitals relative to the movement to general supervision.
- To work through several case studies to illustrate the intricacies surrounding the incident-to concept.
- Overview of the Incident-To Concept
- Areas of Applicability of Incident-To Services
- Compliance Concerns Surrounding the Incident-To Concept
- Physician Supervision Requirements
- Incident-To and The Social Security Act
- Physician Payment Through Incident-To Services
- Hospital Payment Through Incident-To Services
- Self-Administrable Drugs
- Understanding the Two Different Uses of the Phrase Incident-To
- Hospital Services Benefit Categories
- Incident-To Billing for Physicians
- Physician Billing For Subordinate Staff Services
- Presumptive Freestanding Clinic
- Specific Requirements for Physicians
- Physician Supervision Requirements
- Special Concerns for Non-Physician Practitioners
- Incident-To Services for Hospitals
- Hospital Payment For All Services Incident-To Physicians
- Presumptive Provider-Based Setting
- Physician Supervision Rules
- Specific Impacts for Hospitals
- Physician Supervision
- Change for Direct Supervision to General Supervision
- Special Requirements for Freestanding Clinics
- Special Requirements for Hospitals
- Documenting Physician Supervision
- Associated Impacts of the Incident-To Concept
- Provider-Based Rule
- 3-Day Payment Window
- CAHs and Small Rural Hospitals
- Case Studies
- Live Q&A Session
- Compliance Personnel
- Coding Personnel
- Billing Personnel
- Reimbursement Personnel
- Financial Analysts
- Health Information Management Personnel
- Financial Personnel
- Patient Financial Services Personnel
- Chargemaster Coordinators
- Provider-Based Clinic and/or Clinical Operations Personnel
- Physicians and Practitioners
- Other Interested Personnel
About the Presenter:
Duane C. Abbey, Ph.D., CFP, is a management consultant and president of Abbey & Abbey Consultants, Inc., a consulting firm specializing in healthcare and related areas. Duane earned his graduate degrees at the University of Notre Dame and Iowa State University and has more than 20 years of experience as a consultant. Dr. Abbey works extensively in all areas relating to compliance reviews, coding, billing and reimbursement with particular emphasis on the chargemaster and outpatient payment. His consulting activities include hospitals and physicians based clinics.
In addition to his consulting practice, Dr. Abbey also teaches workshops and makes presentations on a regular basis. He has taught at the University level and speaks nationally. He is a regular presenter for hospital associations, medical societies, Boards of Trustees and various other organizations and groups. In addition, professional societies such as HFMA use Dr. Abbey’s services to present seminars and workshops.
Dr. Abbey is a nationally recognized expert in payment systems. A special area of expertise includes APGs/APCs. He is recognized as the leading expert in the nation in APGs/APCs by the thousands who have attended his seminars, read his publications and/or contracted for his services. Attendees at these seminars over the years have included personnel from hospitals, clinics, integrated delivery systems and multiple consulting firms.
Dr. Abbey is also the author of numerous articles and books including: Compliance for Coding, Billing & Reimbursement, Outpatient Services: Designing, Organizing & Managing Outpatient Resources, ChargeMaster: Review Strategies for Improved Billing and Reimbursement, Ambulatory Patient Group Operations Manual, published by McGraw-Hill and Non-Physician Providers: Guide to Coding, Billing & Reimbursement, Chargemasters: Strategies to Ensure Accurate Reimbursement and Compliance, and Emergency Department Coding & Billing: A Guide to Reimbursement & Compliance published.
You will receive an email with login information and handouts (presentation slides) that you can print and share to all participants at your location.
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